Antidepressant Medication
Use during Breastfeeding

We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time

Many Leaders have noticed
an increase in the number of calls about breastfeeding and the use of
antidepressant medications, particularly the tricyclic antidepressants
and the selective serotonin reuptake inhibitors.

While psychotropic medications
(drugs that affect the mind) have been in use for more than 30 years,
little information is available on the effects of these drugs in breastfed
infants. What is available is based on isolated case reports in the
medical literature.

Physicians and pharmacologists
have published their opinions about the use of these medications by
nursing mothers. While they may disagree on the advisability of individual
drugs, they do agree that the potential long-term effects of psychoactive
substances on the infant's brain and nervous system are unknown.

Probably the most widely
cited and most highly respected opinion is found in the 1994 American
Academy of Pediatrics (AAP) drug list, The Transfer of Drugs and
Other Chemicals Into Human Milk, reprinted in the 1997 edition of
the BREASTFEEDING ANSWER BOOK, pages 525-38. The AAP Committee on Drugs
considers all antidepressants to be "drugs whose effect on nursing infants
is unknown but may be of concern."

In light of the varied opinions
on antidepressant use by breastfeeding mothers, the best we can so for
a mother is to share information from the literature:

Maternal peak serum
concentration The time at which a drug is at its highest level
in the mother's blood.

Drug half-life
The amount of time it takes for the drug serum concentration to decrease
by one-half. This term is used to estimate how fast a drug leaves
the body.

Milk-to-plasma ratio
(M/P ratio) The concentration of a medication in milk and in plasma.
Concern is raised when a drug has an M/P ratio greater than one.

This information is available
for most of the antidepressants in commonly used drug references available
through your Professional Liaison Leader.

In addition, Leaders can
discuss strategies for dialogue with the mother's doctor, tell her we
cannot recommend alternatives and let her make her own decision (in
consultation with her doctor) about a drug's use--just as we do for
all medications.

It is a good idea to check
several references to see if the information on a particular medication
is the same. Sometimes it isn't. In that case, a mother needs to hear
the information from each reference so she can make an informed choice.
This can also help her understand why she may be getting different opinions
from her doctors.

If a mother requests the
names of alternative medications, it is the physician's responsibility
to provide the names of the drugs: then we can share what we know about
them. We can share a drug review with a physician who is looking
for more options. Contact your Professional Liaison Leader for more
information.

Betty Crase, former Director
of the Center for Breastfeeding Information (CBI) at LLLI Headquarters,
shared her concerns in a mailing to the PL advisors about a Leader's
responsibility in regard to discussions of medications:

When a Leader is wearing
her "Leader hat," her responsibility is to follow LLLI lay counseling/helping
guidelines. Leaders do not give medical opinions or advice. Leaders
quote verbatim from LLLI-approved sources about the specific drug
of concern . Leaders do not suggest/prescribe alternative drugs on
their own; this is the realm of the licensed health professional.

Please refer to the 1997
BREASTFEEDING ANSWER BOOK, pages 500-09; the LEADER'S HANDBOOK, pages
213-14; LEAVEN, Sept/Oct 1986 and May/Jun 1982. These resources outline
the context in which LLL Leaders can appropriately discuss medications.
This is the extent of information covered by our Leader liability
insurance and the standard to which we are held accountable--no more.

Women who suffer from postpartum
depression require treatment that may include self-help measures, counseling,
medication, and/or hospitalization. Research has shown that counseling
can be as effective as medication in some instances, thereby removing
the concern of drug use during breastfeeding.

A Leader provides information
and support to enable the mother to avoid weaning and separation from
her baby while continuing her prescribed methods of treatment. We do
this by focusing on our experience as mothers, our knowledge of breastfeeding
and our willingness to listen and respect a mother's feelings while
she explores her options.

Additional information on
postpartum depression can be found in the BREASTFEEDING ANSWER BOOK,
pages 482-86 and LEAVEN, Jun/Jul 1996, pages 35-37.

Related resources

Dunnewold, A. and Crenshaw,
J. Breastfeeding and postpartum depression: is there a connection? BREASTFEEDING
ABSTRACTS May 1996; vol.15, No. 4:25-26.